Deborah Kaye

Positions:

Assistant Professor of Surgery

Surgery, Urology
School of Medicine

Member in the Duke Clinical Research Institute

Duke Clinical Research Institute
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 2002

Washington University in St. Louis

M.D. 2010

Medical College of Wisconsin

M.S. 2017

University of Michigan at Ann Arbor

Fellow, Clinical Research Training Program

National Institutes of Health

General Surgery Intern, Surgery

Johns Hopkins Medicine

Urology Resident

Johns Hopkins Medicine

Fellow, Society of Urologic Oncology, Urology

University of Michigan at Ann Arbor

Publications:

Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy.

OBJECTIVE: To investigate the modified frailty index (mFI) as a preoperative predictor of postoperative complications following radical cystectomy (RC) in patients with bladder cancer. MATERIALS AND METHODS: Patients undergoing RC were identified from the National Surgical Quality Improvement Program participant use files (2011-2013). The mFI was defined in prior studies with 11 variables based on mapping the Canadian Study of Health and Aging Frailty Index to the National Surgical Quality Improvement Program comorbidities and activities of daily livings. The mFI groups were determined by the number of risk factors per patient (0, 1, 2, and≥3). Univariable and multivariable regression were performed to determine predictors of Clavien 4 and 5 complications, and a sensitivity analysis was performed to determine the mFI value that would be a significant predictor of Clavien 4 and 5 complications. RESULTS: Of the 2,679 cystectomy patients identified, 843 (31%) of patients had an mFI of 0, 1176 (44%) had an mFI of 1, 555 (21%) had an mFI of 2, and 105 (4%) had an mFI≥3. Overall, 1585 (59%) of patients experienced a Clavien complication. When stratified at a cutoff of mFI≥2, the overall complication rate was not different (61.7% vs. 58.3%, P = 0.1), but the mFI2 or greater group had a significantly higher rate of Clavien grade 4 or 5 complications (14.6% vs. 8.3%, P<0.001) and overall mortality rate (3.5% vs. 1.8%, P = 0.01) in the 30-day postoperative period. The multivariate logistic regression model showed independent predictors of Clavien grade 4 or 5 complications were age>80 years (odds ratio [OR] = 1.58 [1.11-2.27]), mFI2 (OR = 1.84 [1.28-2.64]), and mFI3 (OR = 2.58 [1.47-4.55]). CONCLUSIONS: Among patients undergoing RC, the mFI can identify those patients at greatest risk for severe complications and mortality. Given that bladder cancer is increasing in prevalence particularly among the elderly, preoperative risk stratification is crucial to inform decision-making about surgical candidacy.
Authors
Chappidi, MR; Kates, M; Patel, HD; Tosoian, JJ; Kaye, DR; Sopko, NA; Lascano, D; Liu, J-J; McKiernan, J; Bivalacqua, TJ
MLA Citation
Chappidi, Meera R., et al. “Frailty as a marker of adverse outcomes in patients with bladder cancer undergoing radical cystectomy..” Urol Oncol, vol. 34, no. 6, June 2016, pp. 256.e1-256.e6. Pubmed, doi:10.1016/j.urolonc.2015.12.010.
URI
https://scholars.duke.edu/individual/pub1426609
PMID
26899289
Source
pubmed
Published In
Urol Oncol
Volume
34
Published Date
Start Page
256.e1
End Page
256.e6
DOI
10.1016/j.urolonc.2015.12.010

Do African American patients treated with radical cystectomy for bladder cancer have worse overall survival? Accounting for pathologic staging and patient demographics beyond race makes a difference

© 2016 - IOS Press and the authors. All rights reserved. Background: It is estimated that 74,000 men and women in the United States will be diagnosed with bladder cancer and 16,000 will die from the disease in 2015. The incidence of bladder cancer in Caucasian males is double that of African American males, but African American men and women have worse survival. Although factors contributing to this disparity have been analyzed, there is still great uncertainty as to why this disparity exists. Objective: To evaluate whether the disparities in bladder cancer survival after radical cystectomy for transitional cell carcinoma (TCC) of the bladder amongst African American (AA) and Caucasian patients is attributable to patient demographics, year of diagnosis, and/or tumor characteristics. Methods: Using Surveillance, Epidemiology, and End Results Program (SEER) data from 1973-2011, African American and Caucasian patients treated with a radical cystectomy for TCC of the bladder were identified. Primary outcomes were all-cause and cancer-specific mortality. Differences in survival between African Americans and Caucasian patients were assessed using chi-square tests for categorical variables and Student's t-tests for continuous variables. Cox proportional hazards regression was used to measure the hazard ratio for African Americans compared to Caucasians for all-cause and cancer-specific mortality. In addition, coarsened matching techniques within narrow ranges, were used to match African American and Caucasian patients on the basis of age, sex, and cancer stage. Following matching, differences in all-cause and cancer-specific mortality were again assessed using a stratified Cox proportional hazards model, using the matching strata for the regression strata. Results: The study cohort consisted of 21,406 African American and Caucasian patients treated with radical cystectomy for bladder urothelial cancer, with 6.2% being African American and 73.9% male. African American patients hadworse all-cause and cancer-specific mortality in the univariable analysis (all-cause: HR: 1.23; 95% CI 1.15-1.32, p < 0.001); bladder-cancer specific: HR 1.21; 95% CI 1.11-1.33; p < 0.001). However, after accounting for sex, age, year of diagnosis, marital status, region of treatment, and stage at cystectomy, all-cause mortality was significant (HR 1.20; 95% CI 1.12-1.29; p < 0.0001), but not bladder-cancer specific mortality (HR 1.09; 95% CI 1.00-1.20; p < 0.053). Predictors of bladder cancer specific mortality were age, sex, stage of disease, and marital status. The matched analysis yielded a roughly 1 : 15 match, with 22,511 Caucasians being matched to 1,509 African American patients. In the matched analysis, African Americans had increased all-cause mortality (HR 1.17; 95% CI 1.09-1.26; p < 0.0001), but bladder-cancer specific mortality was no longer significant (HR 1.08; 95% CI 0.99-1.18; p < 0.102). Conclusions: African Americans who undergo a cystectomy are more likely to die, but not necessarily solely because of bladder cancer. Although African American patients have worse all-cause and cancer-specific mortality in univariable models, after controlling for sex, age, year of diagnosis, marital status, region of treatment, and stage at cystectomy, African American patients still have worse overall survival, but equivalent bladder-cancer specific survival. Differences in age, sex, and stage at diagnosis explain some, but not all of the differences in survival.
Authors
Kaye, DR; Canner, JK; Kates, M; Schoenberg, MP; Bivalacqua, TJ
URI
https://scholars.duke.edu/individual/pub1426605
Source
scopus
Published In
Bladder Cancer (Amsterdam, Netherlands)
Volume
2
Published Date
Start Page
225
End Page
234
DOI
10.3233/BLC-150041

Understanding the Costs Associated With Surgical Care Delivery in the Medicare Population.

BACKGROUND: Surgical care has been largely untargeted by Medicare payment reforms because episode costs associated with its delivery are not currently well understood. OBJECTIVE: To quantify the costs of inpatient and outpatient surgery in the Medicare population. METHODS: We analyzed claims data from a 20% national sample of Medicare beneficiaries (2008-2014). For a given study year, we identified all inpatient and outpatient procedures and constructed claims windows around them to define surgical episodes. After summing payments for services rendered during each episode, we totaled all inpatient and outpatient episode payments by surgical specialty. For inpatient episodes, we determined component payments related to the index hospitalization, readmissions, physician services, and postacute care. For outpatient episodes, we differentiated by the site of care (hospital outpatient department versus physician office versus ambulatory surgery center). We used linear regression to evaluate temporal trends in inpatient and outpatient surgical spending. Finally, we estimated the contribution of surgical care to overall Medicare expenditures. RESULTS: Total Medicare payments for surgical care are substantial, representing 51% of Program spending in 2014. They declined modestly over the study period, from $133.1 billion in 2008 to $124.9 billion in 2014 (-6.2%, P = 0.085 for the temporal trend). While spending on inpatient surgery contributed the most to total surgical payments (69.4% in 2014), it declined over the study period, driven by decreases in index hospitalization (-16.7%, P = 0.002) and readmissions payments (-27.0%, P = 0.003). In contrast, spending on outpatient surgery increased by $8.5 billion (28.7%, P < 0.001). This increase was realized across all sites of care (hospital outpatient department: 36.6%, P < 0.001; physician office: 22.1%, P < 0.001; ambulatory surgery center: 36.6%, P < 0.001). Ophthalmology and hand surgery witnessed the greatest growth in surgical spending over the study period. CONCLUSIONS AND RELEVANCE: Surgical care accounts for half of all Medicare spending. Our findings not only highlight the magnitude of spending on surgery, but also the areas of greatest growth, which could be targeted by future payment reforms.
Authors
Kaye, DR; Luckenbaugh, AN; Oerline, M; Hollenbeck, BK; Herrel, LA; Dimick, JB; Hollingsworth, JM
MLA Citation
Kaye, Deborah R., et al. “Understanding the Costs Associated With Surgical Care Delivery in the Medicare Population..” Ann Surg, vol. 271, no. 1, Jan. 2020, pp. 23–28. Pubmed, doi:10.1097/SLA.0000000000003165.
URI
https://scholars.duke.edu/individual/pub1426593
PMID
30601252
Source
pubmed
Published In
Ann Surg
Volume
271
Published Date
Start Page
23
End Page
28
DOI
10.1097/SLA.0000000000003165

Robotic surgery in urological oncology: patient care or market share?

Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.
Authors
Kaye, DR; Mullins, JK; Carter, HB; Bivalacqua, TJ
MLA Citation
Kaye, Deborah R., et al. “Robotic surgery in urological oncology: patient care or market share?.” Nat Rev Urol, vol. 12, no. 1, Jan. 2015, pp. 55–60. Pubmed, doi:10.1038/nrurol.2014.339.
URI
https://scholars.duke.edu/individual/pub1426602
PMID
25535000
Source
pubmed
Published In
Nat Rev Urol
Volume
12
Published Date
Start Page
55
End Page
60
DOI
10.1038/nrurol.2014.339

Confirmatory Magnetic Resonance Imaging with or without Biopsy Impacts Decision Making in Newly Diagnosed Favorable Risk Prostate Cancer.

PURPOSE: We investigated how magnetic resonance imaging and post-magnetic resonance imaging biopsy impact decision making in men considering active surveillance. MATERIALS AND METHODS: We reviewed the records of men in the Michigan Urological Surgery Improvement Collaborative with newly diagnosed favorable risk prostate cancer. Following diagnostic biopsy the men were classified into 3 groups, including group 1-no magnetic resonance imaging, group 2-magnetic resonance imaging only and group 3-magnetic resonance imaging/post-magnetic resonance imaging biopsy. For the purposes of counseling and shared decision making magnetic resonance imaging results were deemed reassuring (PI-RADS™ [Prostate Imaging Reporting and Data System] 3 or less) or nonreassuring (PI-RADS 4 or greater). Similarly, if the diagnostic biopsy was GG (Grade Group) 1, post-magnetic resonance imaging biopsy results were deemed nonreassuring if there was any amount of GG 2 or greater. If the diagnostic biopsy was GG 2, post-magnetic resonance imaging biopsy results were deemed nonreassuring if more than 3 cores were GG 2, or there was more than 50% GG 2 in any individual core or any volume of GG 3 or greater. RESULTS: Of 1,461 men with favorable risk prostate cancer 1,223 (84%) did not undergo magnetic resonance imaging, 157 (11%) underwent magnetic resonance imaging alone and 81 (6%) underwent magnetic resonance imaging and post-magnetic resonance imaging biopsy. Of the men who underwent magnetic resonance imaging alone more with reassuring findings elected active surveillance than men with nonreassuring or magnetic resonance imaging findings (74% vs 35% and 42%, respectively). The highest rate of active surveillance was noted in men with reassuring post-magnetic resonance imaging biopsy regardless of whether magnetic resonance imaging was reassuring or nonreassuring (93% and 96%, respectively). CONCLUSIONS: Magnetic resonance imaging and post-magnetic resonance imaging biopsy drive decision making in men with newly diagnosed, favorable risk prostate cancer. Post-magnetic resonance imaging biopsy is a stronger driver of decision making than magnetic resonance imaging alone. This was demonstrated by the more than 90% of men with reassuring post-magnetic resonance imaging biopsies who elected active surveillance regardless of magnetic resonance imaging results.
Authors
Ginsburg, KB; Arcot, R; Qi, J; Linsell, SM; Kaye, DR; George, AK; Cher, ML; MUSIC,
MLA Citation
Ginsburg, Kevin B., et al. “Confirmatory Magnetic Resonance Imaging with or without Biopsy Impacts Decision Making in Newly Diagnosed Favorable Risk Prostate Cancer..” J Urol, vol. 201, no. 5, May 2019, pp. 923–28. Pubmed, doi:10.1097/JU.0000000000000059.
URI
https://scholars.duke.edu/individual/pub1426594
PMID
30694939
Source
pubmed
Published In
The Journal of Urology
Volume
201
Published Date
Start Page
923
End Page
928
DOI
10.1097/JU.0000000000000059